Executive Director's Column: Breaking the link to employer-based health insurance
From the Massachusetts Nurse Newsletter
January 2009 Edition
Executive Director's Column
By Julie Pinkham
By the end of December, many of you probably happily took down your 2008 calendar and swapped it out for a brand new 2009 version. 2008, after all, was a pretty tough year given that we were sideswiped with an economic meltdown that, for the most part, resulted in fallout that we couldn’t possibly have imagined.
There was some good news in 2008 though: the nation’s elected leaders and economic experts seem to have acknowledged the fact that economic trends don’t just affect a single socioeconomic group. If left unattended, unchecked or unresolved, dangerous economic trends will—in essence—go viral. Today, thankfully, we are making some strides in balancing a previously unbalanced system.
But the financial meltdown of 2008 is not the only current relevant example of an essential system that has been left unattended, unchecked and unresolved. As nurses you can see this same example at work every day in your hospitals. The question in this scenario though is when and how the system will be attended to, checked on and repaired.
Health care in the United States is one of the greatest failures of the 20th century. We grew an economy in which health care—unlike any other industrialized nation—was a benefit to be negotiated with the employer. We carved out some exceptions of course: the elderly, the poor, the disabled and children. But we left the vast majority of our citizens to deal with health care in the context of the employee/employer relationship.
As global completion grew, health care benefit costs became a noose around employer’s necks. But instead of moving to resolve the issue as a flaw in our social fabric, employers opted to cut costs and benefits. Now—as the economy implodes and the automakers look for the taxpayer bailout, we need to ask ourselves whether or not this fundamental flaw can go unaddressed.
But what are some of the components that we most want for ourselves in a health insurance program—whether that program is a single payer program or not? Well, freedom of choice, both in terms of clinicians and facilities, would be nice. I’d like to know that once I’ve established a relationship with my primary care practitioner (not one from a list supplied by my insurer) that I can then stay with that individual . . . unlike today when the employer decides that the insurance is too expensive and forces you to switch plans. I’d like to see medical testing, prescriptions management and treatment plans centralized and made available to clinicians working with me.
I’d like to spread the health risk across everyone so that the cost to each of us is more affordable as opposed to insurance industries carving out populations to diminish risk and adjust premiums to make a profit.
I’d like clinical data for clinical research usable so that we could all benefit from the best practices available.
I’d also like to pay for health care in a fair manner. And I’d like to adopt a system for doing so that has already been successful rather than create new bureaucracies so insurance industries can maintain the cash cow of American health care.
I’d like a health system that allows our economy to grow—to encourage the small start up groups and small businesses, the backbone of our economy, to recruit and retain talent without their employees having to leave to find better health benefits as they start their families or find themselves with an illness or medical issue for which they had no control over.
In short, I’d like to have Medicare now. I’ll pay for it. I’m already paying for it for when I’m 65. I’d like to just go ahead and pay for it now and have it now. As far as the insurance industry, I’m sure they’ll find something to sell me—insurance for dental care, eye care, private rooms, cosmetic care—no doubt the list will grow. I’m thinking they’ll survive and likely make a hefty profit elsewhere, but for me I’d like to have the best chance at a long healthy life. I think my best shot—Medicare for all. It’s time to raise our expectations.